| East Northport Medical Care Pllc | |
|
554 Larkfield Rd Suite 101 East Northport NY 11731-4205 | |
| (631) 368-9166 | |
| (631) 368-5682 |
| Full Name | East Northport Medical Care Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 554 Larkfield Rd, East Northport, New York |
| Authorized Official Name and Position | Anthony J Antonucci (PARTNER) |
| Authorized Official Contact | 6313689166 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Northport Medical Care Pllc 554 Larkfield Rd Suite 101 East Northport NY 11731-4205 Ph: (631) 368-9166 | East Northport Medical Care Pllc 554 Larkfield Rd Suite 101 East Northport NY 11731-4205 Ph: (631) 368-9166 |
| NPI Number | 1932431103 |
|---|---|
| Provider Enumeration Date | 02/12/2010 |
| Last Update Date | 05/19/2010 |
| Medicare PECOS PAC ID | 2668502022 |
|---|---|
| Medicare Enrollment ID | O20100610000785 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932431103 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 226879 (New York) | Secondary |
| 207R00000X | Internal Medicine | 170689 (New York) | Primary |
| Provider Name | Amir Herman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306867494 PECOS PAC ID: 0547278715 Enrollment ID: I20060329000579 |
| Provider Name | Rose Nkolika Ezeani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609921568 PECOS PAC ID: 4688754534 Enrollment ID: I20080103000722 |
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